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BESTMED PACE 1 2019

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Medical Aid Year: 
2019
In Hospital Benefits
Hospital Rate of Payment: 
100% Scheme tariff
Hospitals: 

No Hospital Network

Specialists: 
100% Scheme tariff
Radiology and pathology: 
100% Scheme tariff
MRI and CT scans: 
100% of Scheme tari Limited to R13 223 per family
Organ Transplants: 
100% Scheme tari (only PMBs)
Oncology / Cancer: 
Oncology Programme PMBs only at DSP
Neck and Back Operations: 
R29 777 per beneficiary
Joint Replacements: 
Joint replacement surgery (except for PMBs). PMBs subject to prosthesis limits:
Prosthesis: 

Limits per beneficiary:
- Vascular R29 777
- Pacemaker dual chamber
R50 848
- Endovascular and
cathether based
procedures - no benefit
- Spinal R29 777,
- Artificial disk - no benefit
- Drug eluting stents - DSP
products only
- Mesh R11 180
- Gynaecology / Urology
R9 063
- Lens implants R6 128 per
lens per eye
- Functional R14 674

Joint replacement surgery
(except for PMBs). PMBs
subject to prosthesis limits:
Hip replacement and other
major joints R30 315
Knee replacement R40 313
Other minor joints R12 524

Medical and Surgical Appliances: 
Savings First. 100% Scheme tari Limited to R10 428 per family. Subject to day-to-day overall limit and hearing aid every 24 months
Maternity Confinements: 
100% Scheme tariff
Take home Medicine: 
100% Scheme tari Limited to 7 day's supply
Rehabilitation, Hospice and Step-down facilities: 
100% Scheme tari Limited to 21 days or R29 240 per beneficiary Subject to network facilities
Treatment for Mental Health: 
100% Scheme tari Limited to 21 days per beneficiary
Ambulance Service: 
100% Scheme tari. Pre-authorised and rendered by ER24
International Travel Benefit: 
Yes
Day-to-day benefits
GP consultations: 

100% Scheme tariff

Specialist consultations: 

100% Scheme tariff

Acute medicine: 

Savings first.
Limited M= R2 129, M1+
=R4 408. Subject to overall
day-to-day limits. Subject
to MRP

Over-the-counter (OTC) Medicine: 

Savings account. Limited to
R550 or self-payment gap
member must choose option

Optometry benefits: 
Every 24 months: Consultation 1 per beneficiary at network provider
Basic dentistry: 
Savings first. Limited M=R3 740, M1+ =R7 590 (Subject to day-to-day overall limit)
Specialised Dentistry: 
Savings first. Limited M=R3 740, M1+ =R7 590 (Subject to day-to-day overall limit)
Orthodontics: 

Orthodontics are subject to
pre-authorisation.

MRI and CT Scans (Out of Hospital): 
100% of Scheme tariff Limited to R13 223 per family
Radiology and Pathology: 
100% Scheme tari
Pregnancy benefits: 
HRA completion required 100% Scheme tari 9 x antenatal consultations at either GP/Gyne/Midwife 1x 2D ultrasound nuchal translucency scan at 10-12 weeks at gyne 1x 2D ultrasound scan at 20-24 weeks at gyne 1x 2D ultrasound scan first trimester at radiologi
Chronic Conditions
Chronic Conditions: 

26 conditions, according to Chronic Disease List in Prescribed Minimum Benefits - no annual limit applies. —— Addison’s disease —— Asthma —— Bipolar mood disorder —— Bronchiectasis —— Cardiac dysrhythmias —— Cardiac failure —— Cardiomyopathy —— Chronic obstructive pulmonary disease —— Chronic renal disease —— Coronary artery disease —— Crohn’s disease (excl. biologicals such as Revellex*) —— Diabetes insipidus —— Diabetes mellitus Type 1 —— Diabetes mellitus Type 2 —— Epilepsy —— Glaucoma —— Haemophilia —— Hyperlipidaemia —— Hypertension —— Hypothyroidism —— Multiple sclerosis (excl. biologicals such as Avonex*, subject to protocols) —— Parkinson’s disease —— Rheumatoid arthritis (excl. biologicals such as Revellex and Enbrel*) —— Schizophrenia —— Systemic lupus erythematosus —— Ulcerative colitis.

Preventative Care Benefits
Preventative Benefits: 

Flu vaccines ,
*Pneumonia vaccines
Paediatric
immunisations, Female
contraceptives - R2 096 per
family, *DBC programme,
Preventative Dentistry (incl
gloves and sterile
equipment), HIB titre,
*Mammogram, *Pap smear,
*HPV vaccinations, *Pap
smear - ages 18 and above,
every 24 months

*Biometric Screenings at
contracted pharmacy or
onsite at employer,
*Fitness Assesment at
contracted BASA
biokeneticist - 1 pbpa (ages
older than 13), *Family
dietician assesment - 1pfpa
*Occupational Health
assesement - 1 pbpa (ages
3-12), *Baby Growth
assesment at contracted
nurse - 3pbpa (ages 0 mnth
- 3 years), 3X dietician
consultations pbpa (ages
18+) pre-approval required
3x biokineticist
consultations pfpa
pre-approval required

Total Contributions
Total Contribution Main Member: 
3609.00
Total Contribution Adult: 
2534.00
Total Contribution Child*: 
911.00
Pace 1
Monthly Medical Savings
Savings Child*: 
173.00
Savings Adult: 
481.00
Savings Main Member: 
686.00
Risk Contributions
Risk Contribution Main Member: 
2923.00
Risk Contribution Adult: 
2053.00
Risk Contribution Child: 
738.00
Medical Aid Plan Name Term: 
Any